De novo erectile dysfunction after first myocardial infarction: systematic review and meta-analysis

Background Erectile dysfunction (ED) is increasingly recognized as a marker of vascular health, yet its incidence following myocardial infarction (MI) remains imprecisely defined. Aim To quantify the pooled incidence of de novo ED after first-time MI and to examine its correlates. Methods Via a systematic review and meta-analysis, PubMed/MEDLINE and Web of Science were searched from inception to June 10, 2025, for studies enrolling adult men without prior ED and assessing post-MI ED using validated instruments (5-item International Index of Erectile Function or 15-item International Index of Erectile Function). Incidence estimates were pooled using random-effects meta-analysis and between-study heterogeneity assessed with I2. Sensitivity analyses included leave-one-out models; narrative syntheses described timing of onset and secondary sexual outcomes. Outcomes The main primary outcome was pooled incidence of de novo ED after first MI, while secondary outcomes included timing of ED onset, severity correlates, and changes in sexual activity/intercourse frequency. Results Five studies (n = 428 MI survivors) met inclusion criteria. Among the 428 men, 271 developed new ED post-MI, yielding a pooled incidence of 64.4% (95% CI, 44.0-85.0). Between-study heterogeneity was high (I2 = 90%). Narrative data indicate that most cases manifest within 6 months post-MI, and severity correlates with age and comorbid burden. Reporting on sexual activity resumption and intercourse frequency revealed significant declines compared to pre-MI levels. Clinical Implications De novo ED is common and arises early after first MI. If clinically suspected, screening for sexual dysfunction, incorporation of structured sexual counseling into cardiac rehabilitation, and timely consideration of therapeutic interventions may be considered to improve quality of life and potentially signal broader cardiovascular risk. Strengths and Limitations Focus on incident cases and use of validated ED instruments showing likely association in MI-ED development, but limited by small number of eligible studies, incomplete baseline reporting, and high between-study heterogeneity limiting precision. Conclusion New-onset ED affects a substantial proportion of men after a first MI and commonly appears within months of the event. These findings may warrant consideration of assessment of sexual function in post-MI care and integration of targeted interventions into recovery programs.